The 1970s: Era of alternatives

By the early 1970s, the development movement was running out of steam. The
idea that transfers of capital and technical know-how would quickly dispense
with gross poverty had proved misconceived. During the previous decade, many
developing countries had achieved high rates of economic growth -- increases of
5 per cent or more in GNP -- but little of this
had 'trickled down' to the poor. On the contrary, their numbers had swollen --
as had the gap between rich and poor people, and between rich and poor nations.
The rates of population growth were partly to blame; but equally important were
policies based on simplistic assumptions. This much had become clearer to the
growing community of development analysts attached to universities, governments
and international organizations. They busily began to diagnose what had gone
wrong and set out on the quest for alternatives.

This led to a new climate of development thinking. Since economic growth did
not automatically sweep poverty away, development analysts decided that the
second Development Decade must also include measures deliberately targeted at
the poor -- to help them meet their basic needs for food, water, housing, health
and education.

In the past, economists and planners had looked upon these rather as forms
of 'consumption' unconnected to economic productivity. Now their thinking began
to change. In 1972, Robert McNamara, then President of
the World Bank, made what was seen as a
landmark statement. Governments in developing countries, he said, should
redesign their policies so as to meet the needs of the poorest 40 per cent of
their people -- and relieve their poverty directly. The cornerstone of the new
development strategy was thus an explicit attack on poverty -- albeit one so
mounted as not to damage economic prospects. Its economic slogans were:
'redistribution with growth', and 'meeting basic needs'.

As policy makers began to focus less on economies and more on people, they
realized that those bit-players, the humanitarians, had actually met the new
criteria for success rather well. While the economic planners had focused on
dams and factories, the humanitarians had focused on the village, the community,
the family and the individual. They appeared to be putting into effect British
economist E. F. Schumacher's concept that 'small is beautiful' -- a proposition
that seemed to encapsulate the spirit of the era. NGOs
, with their localized mini-projects, already enjoyed an intimate
relationship with the poor; UNICEF had similar advantages. Although it worked at
one stage removed, its connections with communities were certainly much closer
than those of any other player in the UN
hierarchy. Within the development club, the programmes supported by the
humanitarians, including UNICEF, began to enjoy a new legitimacy.

Figure 6: Total debt as a percentage of GNP increased in
all regions over the period 1971-1993. Latin America's high debt levels of the
1980s have since fallen. Sub-Saharan Africa's debt, which has continued to
soar, now surpasses its GNP. Source: World Bank, World debt tables
1994-95, volume 2, Washington, D.C., 1994. Note: Data for sub-Saharan Africa
excludes South Africa.

Figure 7: The percentage of underfives who are underweight -- one
measure of malnutrition -- has dropped in most regions. Improvement has been
only marginal between 1975 and 1990 in sub-Saharan Africa.
Source: United Nations, Second report on the world nutrition
situation, Subcommittee on Nutrition, Geneva, 1992.

The early 1970s saw two events of particular significance for international
development. One was the OPEC oil shock, which
sent prices soaring and ended the era of cheap energy and cheap
industrialization -- and therefore of cheap development. The other was the
global food shortage brought about by two disastrous world harvests in 1972 and
1974. The UN responded to the atmosphere of crisis with a series of
international conferences: on environment (Stockholm, 1972); population
(Bucharest, 1974); food (Rome, 1974); women (Mexico City, 1975); human
settlements (Vancouver, 1976); employment (Geneva, 1976); water (Mar del Plata,
1977); and desertification (Nairobi, 1977). Meanwhile, the countries of the
developing world were growing in confidence.

Encouraged by the success of the OPEC cartel in 1974, they demanded a new
international economic order: a change in relationships among the nations to
allow the up-and-coming members of the international community to gain access to
world trade and financial markets.

These events and the currents of thinking they unleashed had important
repercussions in UNICEF. The oil price hike also meant higher prices for
fertilizers and all the equipment needed to increase agricultural production.
And the world food shortage had serious implications for the health and
well-being of the 500 million children who lived in the countries designated
'most seriously affected'. In 1974, the UNICEF Executive Board made a formal
declaration of an 'Emergency for Children'. It was believed that even before the
crisis struck, some 10 million children worldwide suffered severe dietary
shortage. As the price of food continued to rise, child hunger and malnutrition
were bound to increase.

At the prompting of Henry Labouisse and his deputy, Dick Heyward, UNICEF was
also urgently considering what kind of programme strategy would reach children
more cost-effectively. In 1975, the UNICEF Executive Board reviewed the findings
of two important studies: one into the priorities for child nutrition in the
developing world and another, conducted with WHO
, into 'alternative methods of meeting basic health needs'. From their
conclusions, together with those of an earlier study into education, UNICEF's
own version of the alternative order was rapidly emerging. It was to be known as
the 'basic services' approach.

According to UNICEF, development was failing to reach large segments of the
poor because existing services for health, education and agricultural extension
were modelled along industrialized-country lines. If the poor had to wait for
their lives to be improved by such services, they would probably wait forever.
Existing services rarely reached as far as the village, and even when they did
they were usually unconnected to each other. Worse, they were often unconnected
to the villagers' own perception of their needs. As an alternative, UNICEF
proposed a range of integrated basic services that would be flexible enough to
be adapted by and within the community.

These basic services would also be community dependent. This approach was
borrowed from the increasing number of community-based programmes in countries
as far apart as Guatemala, Indonesia and Tanzania, which had incorporated a
spirit of volunteerism along with traditional systems of mutual self-help (Panel 9). UNICEF had taken advantage of this by
training and motivating lay members of the community to perform simple tasks
such as baby weighing, early childhood stimulation and basic handpump
maintenance. These volunteers could thus act as 'barefoot' workers delivering
local services. The relatively few highly trained professionals who up to then
had been performing routine activities were freed instead to supervise the
cadres of volunteers. In this way, services could be more widely extended
without exorbitant extra costs.

In 1976, the UNICEF Executive Board committed itself to the basic services
approach. By this time, UNICEF and WHO were already well on the way to agreeing
on an alternative approach to health care. They had seen that health care
structures in developing countries had evolved mainly into pale facsimiles of
the high-tech delivery systems familiar in the industrialized world. Given the
lack of resources, this had distorted priorities and led to a disregard of the
basic principles of public health. Up to 90 per cent of a developing country's
health budget could be absorbed by a handful of city hospitals serving the élite,
while out in the countryside villagers were obliged to walk miles to the most
rudimentary dispensary. The poor might occasionally receive visits from mobile
teams of smallpox eradicators or water engineers, but services they urgently
needed -- notably those for maternal and child health -- were rarely available.

At a time when heart transplants and in vitro fertilization were stunning
the world, millions of people -- up to three quarters of the population in many
countries -- remained beyond the reach of modern health care. Moreover, the
sicknesses that afflicted them, or more usually their children, were simple and
obvious. The poor were suffering and dying from diarrhoea, fevers and
respiratory infections that no longer constituted a threat in the industrialized
world and indeed were viewed there in the most pedestrian terms. They were the
diseases of poverty. And they were disrupting, and in some cases destroying, the
lives of hundreds of millions of children and families.

In 1978, at an international conference in Alma Ata in the then USSR,
Ministers of Health from all over the developing world agreed that their health
delivery systems must be radically restructured to provide 'primary health care'
(PHC) for all their citizens. The critical service was care for mothers and
children before, during and after birth. Added to this were emergency first aid,
surveillance of young child growth, disease control, family planning, safe water
supplies and environmental sanitation. As with basic services, ordinary people
would be enlisted in their own preventive care. This radical vision set an
ambitious goal, 'Health for All by the Year 2000'.

During the first two Development Decades, UNICEF had argued that working for
children was part of a much larger social and economic movement. But this
emphasis on development and on other great issues of the day had a drawback. It
meant that, even within the humanitarian community, the special needs of
childhood and of disadvantaged child groups were in danger of being submerged.
Anxious to project children back into the limelight, the Geneva-based
International Union for Child Welfare and other child-related NGOs managed to
persuade the UN to declare 1979 the International Year of the Child. Initially
reluctant to commit its energies to a celebratory and possibly superficial
affair, UNICEF was eventually persuaded to play a leading role.
IYC proved far from superficial. It was a
remarkable success. The children's cause had reached another turning-point.